Alcohol withdrawal side effects can range from moderate to severe. Among the more common side effects are tremors or “the shakes.” These alcohol withdrawal tremors are part of the body’s response to a sudden decrease or cessation of alcohol consumption after long term, heavy use.
The sudden absence of alcohol sends the body into overdrive as it tries to compensate and stabilize the chemical imbalance caused by alcohol misuse. This process of the body stabilizing itself is called alcohol withdrawal and it often includes tremors.
Use this resource to learn more about why alcohol tremors occur, what to expect and what to do if you or a loved one experiences alcohol tremors.
Alcohol Shakes Key Facts
- Alcohol tremors are involuntary shakes caused by nervous system overactivity
- Alcohol withdrawal shakes typically begin six to 24 hours after the last drink and can last three to five days.
- If tremors progress to delirium tremens or other severe side effects, it is crucial to seek medical support.
- Clinicians can assess the severity of alcohol withdrawal and provide appropriate treatment for tremors, including medications.
- Detox programs and follow up recovery treatment are available to address both physical and psychological aspects of alcohol use disorder.
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What Are Alcohol Withdrawal Shakes? (a.k.a. Alcohol Tremors)
Alcohol tremors are a common part of alcohol withdrawal syndrome (AWS). These tremors are an involuntary response that happen as the body adjusts to the absence of alcohol and are also called shakes.
This withdrawal side effect is the reason many people have shaky hands after drinking stops. The tremors are an indication that your body has become physiologically dependent on alcohol, and the withdrawal process has started.
Alcohol Shakes vs. Hangover
How can you tell the difference between alcohol shakes and a hangover?
Timeline
- A hangover is the most intense when it begins and then improves throughout the day.
- Withdrawal tremors don’t start until six to 24 hours after the last drink and then increase in intensity.
Severity
- Hangovers typically don’t require medical attention.
- Signs of severe withdrawal symptoms, such as confusion, fever, seizures or hallucinations, should be considered a medical emergency and require immediate support.
Why Do Alcohol Shakes Happen?
Chronic alcohol use causes the body to become dependent on alcohol. Here’s what happens.
- The frequent presence of alcohol alters the brain’s release of GABA (gamma aminobutyric acid), a neurotransmitter that slows the neurological system.
- Alcohol also suppresses the production of glutamate, an excitatory neurotransmitter.
- Over time, the brain adapts to the presence of alcohol, so it no longer produces the normal amounts of these neurotransmitters.
- When alcohol suddenly is not present, the neurotransmitters “rebound” to try to stabilize the body.
- The rebound creates an overexcited central nervous system, which results in anxiety, high heart rate and tremors.
Who is at risk?
Anyone who undergoes alcohol withdrawal may experience alcohol tremors.
You are more likely to experience alcohol shakes if you have one or more of these risk factors:
- If you are a senior
- A medical illness
- Experienced prior severe withdrawal
- Heavy daily alcohol use
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How Long Do Alcohol Tremors Last?
While alcohol tremors are a common side effect of alcohol withdrawal, it’s important to know how long they should last and what to expect.
Alcohol Tremors Timeline
- Onset: 6-24 hours after last drink
- Peak: 24-72 hours
- Recovery: 3-5 days
During this time, it is common to experience sleep disturbances and anxiety. The combination of these symptoms can linger more than a week in some people.
This timeline can vary based on concurrent sedative use, any comorbidities present and your prior drinking patterns.
When to Seek Medical Support
It is possible for withdrawal symptoms to require medical attention. During the first six to 48 hours, the risk of seizures is highest.
Delirium tremens are also a risk, typically during days two through eight after your last drink. These conditions indicate a life threatening level of neurological hyperactivity and require immediate medical support.
When to Call 911
If any of the following red flags appear, or if the person cannot be safely monitored, call 911:
- Repeated vomiting
- High fever
- Seizure
- Confusion/hallucinations
- Fainting
- Chest pain
- Very high blood pressure or heart rate
When to Get Same Day Medical Care
Safe alcohol withdrawal often requires medical care. To ensure symptoms don’t progress to lethal levels, seek same day medical care for the following symptoms:
- Moderate tremor
- Anxiety
- Inability to sleep
- Heart rate above 100
Never “treat” alcohol withdrawal symptoms by drinking. This can worsen symptoms and increase the risk of seizure. Instead, prior to receiving medical care, take the following steps to stay safe:
- Avoid driving
- Drink water and nonalcoholic fluid to remain hydrated
- Arrange for constant supervision to monitor progress
Clinical Assessment & Treatment of Alcohol Withdrawal Shakes
Clinicians can assess the severity of withdrawal to determine appropriate treatment for alcohol shakes.
They use the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) to measure severity. This helps determine what, if any, medications should be prescribed.
CIWA-Ar
The assessment includes a rating scale for 10 withdrawal symptoms:
- Nausea
- Tremor
- Anxiety
- Agitation
- Sweats
- Orientation
- Headache
- Visual disturbance
- Tactile disturbance
- Auditory disturbance
The total score guides clinicians in treatment options.
- 0-9: Mild
- 10-18: Moderate
- 19+: Severe
Scores in the moderate range may indicate a need for medications to assist with withdrawal. Severe withdrawal is usually treated with medications.
Clinicians repeat the assessment to determine the trend of symptoms. They combine these scores with current vital signs and your medical history to guide treatment.
Withdrawal Medications
Several medication and supplement options are used for effective treatment of alcohol withdrawal and alcohol tremors.
Benzodiazepines: (diazepam/lorazepam) These are considered the first line treatment for alcohol withdrawal. They are prescribed using fixed dosing or symptom triggered dosing, to stimulate GABA receptors.
Adjunct medications may be used based on symptoms and medical history. These include:
- Carbamazepine/gabapentin to calm the central nervous system
- Phenobarbital to target GABA and glutamate receptors
- Beta-blockers/clonidine to treat autonomic symptoms
- Thiamine to address thiamine deficiency
Additional support may be provided through antiemetics (nausea medication), hydration and electrolytes.
Choosing the Right Detox Setting
Detox programs are available in inpatient and outpatient settings. It’s important to undergo detox at the appropriate level of care. This chart indicates which setting may be best for your situation.
| Outpatient Detox | Inpatient/Medication Assisted Detox |
| ● Mild symptoms ● Reliable support at home ● Phone/check in access ● No severe comorbidity All boxes should be checked to receive outpatient detox. | ● History of DTs/seizures ● Severe CIWA-Ar score ● Pregnancy ● Older age ● Significant medical or psychiatric illness ● Polysubstance use ● Unstable housing ● Lack of transportation ● Remote location ● Prior complicated withdrawal if any of these boxes are checked, inpatient care is recommended. |
After the Shakes: Staying Alcohol Free
Once withdrawal is complete and alcohol shakes stop, ongoing treatment is vital to maintain sobriety. Support is available in the form of medication, evidence based therapies, and other aftercare options.
Alcohol Use Disorder (AUD) Medications
Clinicians may recommend starting or continuing medications following acute withdrawal stabilization. They will prescribe and dose based on your goals and other medical considerations.
Three medications have been approved by the FDA to treat AUD:
- Acamprosate
- Disulfiram
- Naltrexone
Call A Treatment Provider
For a conversation about what treatment options are available to you.
Make a Call
800-985-8516Sponsored Helpline
Evidence Based Behavioral Therapy
Behavioral therapy methods help you work through root causes of addiction and develop coping skills to prevent relapse.
The most common methods include:
- Cognitive behavioral therapy
- Motivational enhancement therapy
- Contingency management therapy
Mutual/Peer Support
Many individuals in recovery from AUD find support in peer based groups. These organizations offer accountability and encouragement from likeminded peers and offer both in person and online options.
Popular support groups include:
- Alcoholics Anonymous (AA)
- SMART Recovery
- Celebrate Recovery
Aftercare
Each of the options listed above offer crucial aftercare for ongoing recovery. Through these sources or others, it is important to address key areas that affect ongoing health:
- Co occurring mental health disorders (anxiety, depression)
- Insomnia issues
- Nutrition
- Relapse prevention
- Medical follow up
Alcohol Tremors FAQs
Alcohol withdrawal shakes typically start six to 24 hours after the last drink, peak in 24-72 hours, and improve within three to five days.
Lingering tremors and anxiety may last a week or more. If symptoms escalate or new red flags arise, seek medical attention.
No. While it may appear to relieve symptoms, drinking more actually worsens the withdrawal cycle. It also increases seizure risk and the possibility of kindling.
The delay in sobriety also delays treatment and recovery. A safer approach is a medical assessment that determines what evidence based medications can be used to treat your withdrawal symptoms.
Call emergency services immediately in the case of seizures, severe confusion, hallucinations, very high pulse/blood pressure, high intensity headache, high fever or repeated vomiting.
Mild alcohol tremors can be managed at home only under clinician guidance, with a safety plan in place.
This plan must include daily check ins and proper fluid and nutritional intake and driving must be avoided. If symptoms worsen or if supervision is not reliable, it is crucial to escalate to urgent care or emergency services.
Find Treatment Near You
Treatment options for alcohol withdrawal tremors and alcohol addiction are available near you.
Not sure where to start?
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Malibu, CA Claimed | Rise in Malibu is a secluded drug and alcohol rehab program in Malibu, California. They deliver Joint Commission accredited detox, inpatient treatment, medication assisted treatment (MAT), and aftercare services to adult clients. Their campus boasts luxury amenities and a seaside view. Detoxification at Rise Malibu takes place in its luxury residen | Treatments Programs Payment Options AlcoholismDrug AddictionDual DiagnosisOpioid AddictionSubstance Abuse Adult ProgramYoung Adult Program Private InsuranceSelf-Pay Options | 
One of the best rehabs available. Everyone was very personable, respectful, kind, and patient. Just over 365 days sober thanks to Rise. Allison saved me, and I cannot thank her enough. If you’re in deep and hopeless, take her word, do what she recommends, let her guide the process. She is a godsend. Trust her. Ron, Sharie, Dr. Mark, Nam, Cat, Dr. Raskin (who is very kind, don’t let other reviews fool you) and everyone else, thank you as well. My daughter has her dad back thanks to y’all.
Also special shout out to Cesar for our trip out to West Hollywood to check out sober livings. Fun adventure and one of the easiest people to talk to one on one.
Go to Rise. I’m telling you now if you have the opportunity, do not pass it up.
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The first person I met at rise was Nam. He is the man he’s there for you all the time he works 20 hours a day. The man is amazing.
Next, I met Zac the nurse he’s such a cool dude and listens to you and takes whatever concerns you have and it gets it fixed for you.
As far as nurses Daisy, David and Nina were great.
If you have real medical issues, I would not go there
Dr.Raskin is a first class clown. The first time I met him, he spoke to me in the kitchen for 30 seconds and ran away. The next time I saw him was on Zoom for about 60 seconds and he got off. I had a lot of medical issues and he was not there for me. I was very disappointed in that. I refuse to see him after that that’s one of the few bad things about Rise is the doctor. If he was my employee he’d be fired. I complained about him a lot.
The counselor Michael, Josh And Beth were great they listen to you and make you feel like they are helping you out.
A special shout out to Cat My hippie dippy friend she is the one who does yoga and meditation. I never did that in my life before I’m an older man and she was amazing.
I’m from the East Coast. The food was not that great. I was disappointed in that they have a private chef. James was the best chef
That’s the only thing I could say about the food. Very disappointing.
That being said, I would definitely go to Rise. They save my marriage and they save my life. Thank you to the team if I left anybody out, I’m sorry.
Marc K
2 weeks ago
There are very few people in life who truly believe in you when you’ve completely lost belief in yourself. For me, one of those people has always been Ron and the entire team at Rise in Malibu.
I’ve known Ron for a while , and through every chapter, he has remained someone who genuinely cares, shows up, and sees the person beneath the struggle. That kind of authenticity is rare. His leadership and heart are reflected throughout the entire program and staff.
Dr. Mark, Sheri, and everyone at Rise create an environment that is compassionate, professional, supportive, and deeply human. They don’t treat people like problems to fix they treat them like people worth fighting for. That distinction matters more than words can explain.
What makes Rise special is that it never felt transactional to me. It felt personal. Real care, real connection, real support, and people who continue to stay connected long after treatment ends. That says everything.
And for me personally, recovery wasn’t something that necessarily “landed” the very first time. Sometimes the spiritual experience happens when it’s truly ready to happen. What I can say today, sitting here over 16 months sober, is that Rise helped give me the tools, foundation, support, and perspective that allowed that change to finally take root in a real way. When the moment came, I knew how to move forward because of what I had learned there.
That’s something I’ll carry with me for the rest of my life!
I can honestly say I would recommend Rise in Malibu to anyone looking for genuine help, guidance, and people who truly care about recovery and human beings as a whole. Five stars isn’t enough for the impact they’ve had on my life.
Thank you, Ron, and thank you to the entire Rise family!
B P
1 month ago
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6 6 
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Levittown, PA | The Steps To Recovery addiction treatment center is situated in Levittown, Pennsylvania. At this drug rehab center, patients can expect to engage in a unique treatment approach that focuses on helping individuals recover through authenticity, intimacy, community connection, and transparency. Steps to Recovery offers a serene and private environ | Treatments Programs Payment Options AlcoholismDrug AddictionDual DiagnosisMental Health and Substance AbuseOpioid AddictionMental Health Adult ProgramLGBTQ ProgramYoung Adult ProgramMilitary Program Self-Pay Options MonthlyPrivate Insurance | 
Celebrating my milestone today and couldn’t have done it without STR Levittown and Silver Pines, eternally grateful 🫶🙏
Michael Oberholtzer
1 month ago
This place saved my life. At my lowest of lows I came here and they gave me the hope I needed to go out and live a successful life. Erin truly made my day everytime I’d see her she would always give me some kind of inspiration to keep going
Tommy Hayes
3 months ago
My time in the PHP program at STR was truly life-changing. I came in struggling with trauma and uncertainty, and the staff created a safe, supportive space where I could begin to heal and grow.
A special thank you to my case manager Katie for helping me navigate legal issues and plan my next steps when I felt overwhelmed. I’m also deeply grateful to my therapists Matt, Ashley, and Blake, as well as Lauren, the intern, who all supported me through the hardest parts of recovery. Leigh Anne, our house lead behavioral health tech, kept communication open and made sure everyone felt heard. Monique, the nurse practitioner, was incredibly compassionate and helped me take my first steps toward accepting my need to change pronouns and pursue gender-affirming care.
I’m leaving this program stronger, more self-aware, and genuinely thankful for the care I received. 💙
Taylor Budry
3 months ago
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6 6 
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